GPH Chapter 8: Nutrition and Global Health

Rapid Results Initiative for Food Fortification

-African countries have fortified salt with iodine have even made salt fortification a requirement. -Kenya was among the countries fortified salt but not other staple foods -difficulty getting the public and private sectors to work together on fortification- must collaborate -the public sector is responsible for food safety. The private sector is responsible for producing and selling the fortified foods. -By the end of 130 days fortification in many oil products. Vitamin A fortification in edible oils. -increased collaboration and trust between private and public sectors

Tamil Nadu State, India

-Aimed at improving the nutritional status of poor women and children in the rural areas of the state through a set of well focused interventions -focused on improving nutrition education and efforts to improve care and feeding practices for young children -growth monitoring couples with short term supplementary feeding of children who are faltering -kids not growing well received food supplements -nutrition education -less universal and long term than before -reduced levels of malnutrition in the children

Finland Uses Labels to Reduce Salt Consumption

-From 1979 to 1982 a community based intervention to reduce population wide sodium intake called the north Karelia project was conducted to reduce mortality associated with cardiovascular disease -service organizations, schools, nongovernmental organizations, media outlets, and the food industry -Labeling systems reduced the salty content of targeted foods by 20-25% -reduction in sodium intake, diastolic blood pressure, and reduction of overall mortality and mortality due to stroke or heart disease

Brazil: The Agita Sao Paulo Program Uses Physical Activity to Promote Health

-Launched in 1966 to increase the level of knowledge among the Sao Paulo population about the importance of physical activity -Program used 3 types of activities to reach its target group of students, workers, and elderly: Mega-events (reach majority of cities), partner institutions (schools), and partnerships (municipalities to monitor physical activities) -positive effects for physical activity and awareness for physical activity

The challenge of iodine deficiency disease in China

-National Iodine Deficiency Disorder Elimination Program -Public made aware of risk of iodine deficiency (goiters) -Nationwide campaign to switch to iodized salt -control network of production -iodine deficiency reduced dramatically -fortification!!!

window of opportunity

-begins at conception and lasts until the children 2 years of age

South Korea's Promotion of and Adherence to a Traditional Diet

-demonstrated potential for effective public/private collaboration in the pursuit of a healthy diet -Korea Dietetic Association (KDA) nutrition education through seminars local health centers, etc. traditional menus at schools. -High vegetable consumption, low obesity and overweight rates

Folic acid and calcium

-especially important for pregnant women -Helps the body make new cells -found in leafy green vegtables, fruits, beans, peas, and nuts, and enriched proteins like flour. -deficiencies linked with neural tube defects in their children

Nepal Addresses Micronutrient Deficiencies

-families lack income needed to consistently buy nutrient-rich foods -Initiated National Anemia Control Strategy and Iron Intensification Program- provides iron supplements for pregnant women distributed by female community health volunteers, in addition to deworming services, maternal care, and fortified foods. Monitoring system was established to identify pregnant women as soon as possible and to ensure that women fully participate in the recommended services. -Nepal demonstrated that is possible for a country with limited finances to create cost effective programs ti address micronutrient deficiencies. This has been achieved through strong political support, use of community health worker volunteers, effective spread of knowledge about importance of micronutrients, and careful program supervision and monitoring.

Childhood Nutrition Supplementation and Adult Productivity

-followed children for more than 2 decades who participated in supplementary feeding program in order to gauge long term program impact in adulthood in Guatemala. -Institute of Nutrition of Central America and Panama -Children who had received the supplement of protein and energy, atole, scored higher on both tests as adults than those who received fresco (minimal energy) -more economic productivity in boys, not in girls -Positively affected offspring of girls -higher literacy rates and cognitive development

Vitamin A

-found in a variety of plants but mostly in green leafy vegetables, yellow and orange fruits that are not citrus, and carrots. Also found in some animal products. -lack of vitamin this is associated with xerophthalmia- night blindness, eyes dry out, and possible permanent blindness -important to proper functioning of immune system

Iodine

-found in some types of seafood and in plants that are grown in soil that naturally contains this -not much access in mountainous areas -lack of this associated with growth on thyroid called goiter and failure to develop intellectual potential

Macro-level factors related to globalization that affect overweight and obesity

-global financial and trade liberalization, increased per capita income and socioeconomic status, and increased urbanization

Sodium

-high sodium intake can lead to hypertension -major risk factor for stroke and heart disease

Immediate causes of undernutrition

-inadequate dietary intake and illness -lack of access to food in rural areas -lack of safe water and sanitation -child care practices-breast feeding -access to health services-basic immunizations -s factors: socioeconomic status, family income, level of knowledge people have of health and nutritional practices

Overweight and obesity risk factors

-increase in energy intake -genes -cultural and region specific factors: dietary and physical activity

Added Sugars

-large amounts of energy without supplying nutrients -obesity and diabetes

Nutrition devlopment importance

-maternal health-main care giver for children -birthweight and mental devlopment of child -life expectancy -high economic costs -work productivity

Fats

-monounsaturated and polyunsaturated fats found in nuts , plant based oils, and fish are associated with a number of health benefits such as reduce levels of bad cholesterol -Saturated and trans fats found largely in red meat and dairy products

Iron

-most absorbable form found in fish, poultry, and meat. Less absorbable found in fruits, grains, vegetables, nuts, and dried beans. -Lack of iron associated with iron deficiency anemia, which we usually associate with weakness and fatigue -women who are iron deficient have an increased of giving birth to premature or low birthweight baby or hemorrhaging and dying during childbirth. -poor mental development and reduced immune function

Overweight and obesity are especially important for these reason

-prevalence has been increasing in almost all countries -closely linked with a number of noncommunicable diseases such as heart disease, stroke, and diabetes -Prevention of the problems associated with overweight and obesity is complex and involves strategies in a variety of doctors and across individual, local, national, and global spheres

Addressing future nutrition challenges

-problems of undernutrition are severe in South Asia and Sub-saharan Africa -issues of overweight and obesity is growing in low- middle- income countries -about 45% of under 5 child deaths globally are associated with nutritional causes -many infections and diseases reduce ones ability to absorb food. at the same time poor nutritional status reduces immunity to disease -food fortification (widely consumed food product) -vitamin and mineral supplementation -food price modification for overweight and obesity -incentives production and use of healthier substitutes -legislation

Zinc

-red and white meat and shellfish -deficiency linked with growth retardation, impaired immune function, skin disorders, hypogonadism, and cognitive dysfunction

dietary fiber and refined carbohydrates

-removes the majority of fiber and nutrients from grain -starch- increasing blood glucose, obesity, and type 2 diabetes

what percent of the world's population, are obese or overweight?

30%, higher rates in women of all regions

what percentage of deaths can be attributed to nutrition related causes?

45%

Z-score

A statistical term, meaning the deviation of an individual's value from the median value of reference population, divided by the sd of the reference population

Low birthweight

Birthweight less than 2500 grams

Stunting

Failure to reach linear growth potential because of inadequate nutrition or poor health. Stunting is measured as height-for-age two z scores below the international reference

Iodine deficiency disorders

The spectrum of IDDs includes goiter, hypothyroidism, impaired mental function, stillbirths, abortions, congenital anomalies, and neurological cretinism

Vitamin A Deficiency

Tissue concentrations of vitamin A low enough to have adverse health consequences such as increased morbidity and mortality, poor reproductive health, and slowed growth and devlopment, even if there is no clinical deficiency.

Malnutrition

Various forms of poor nutrition. Underweight or stunting and overnight, as well as micronutrient deficiencies

Five micronutrients

Vitamin A, iron, iodine, zinc, and calcium.

body mass index

body weight in kilograms divided by height in meters squared (kg/m^2)

What is the leading risk factor for death of under-5 children globally?

childhood underweight

What are many improvements in nutrition enabled by?

communication efforts, such as the promotion of breastfeeding, the introduction of appropriate complementary foods, and the eating of foods that are rich in certain micro nutrients.

Intake levels of sugar across the globe over the past 4 decades

dramatic increase

rate of underweight children younger than 5 in low middle income countries

fell from 28% in 1990 to 17% in 2011

Where do the vast majority of overweight and obese people in the world today?

low and middle income countries

anemia

low level of hemoglobin in the blood, as evidenced by a reduced quality or quantity of red blood cells

What is the second leading risk factor for death of under-5 children globally?

suboptimal breastfeeding

malnutrition

those who do not get proper nutrition, whether to little, too much, or of the wrong kind.

Undernutrition

underweight for one's age, too short for one's age (stunted), dangerously thin for one's height (wasted), and deficient in vitamins and minerals (micronutrient malnutrition)

Severe acute malnutitionism

very low weight-for-height measurement of below minus 3 standard deviations of the median

Wasting

weight, measured in kgs, divided by height in meters squared, that is two z-scores below the international reference.